SPLENIC Trauma - Dr. Gibbs

Case 1

• Splenic Traumatic Injuries can be very subtle!  Respect it's potential... and persistent tachycardia.
• A pulse of 105 in a 19 yo is NOT normal.
• Abdominal exam can be underwhelming.
• Ask about Pleurisy!

Case 2

• Don't ignore the mechanism of injury.
• Hemorrhaging young patients manifest with increased HR before decreased BP.

Case 3

• Know when chest injury increases the risk for splenic injury.
• Lower rib Fxs, pulmonary contusion, hemo/pneumothorax are concerning.

Case 4

• Know appropriate indications for non-operative therapy.
• Contrast blush indicates arterial bleeding.  91% of patients with a blush had + angiogram. 
• Absence of a contrast blush does NOT mean there is no vascular injury. 39% had + angiogram.
• Need to be MORE aggressive in patients with traumatic brain injury.
• Injury staging is important!
• SHOCK = OR
• Blush = IR
• Neither = Observation

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